2005S0458-1  03/07/05


By:  Deuell                                                       S.B. No. 1210


A BILL TO BE ENTITLED

AN ACT

relating to the uniform fair hearing rules for Medicaid-funded 
services, including services requiring prior authorization.
	BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:                        
	SECTION 1.  Section 531.024, Government Code, is amended to 
read as follows: 
	Sec. 531.024.  PLANNING AND DELIVERY OF HEALTH AND HUMAN 
SERVICES.  (a)  The commissioner shall:
		(1)  facilitate and enforce coordinated planning and 
delivery of health and human services, including:
			(A)  compliance with the coordinated strategic 
plan;                       
			(B)  co-location of services;                                                
			(C)  integrated intake; and                                                  
			(D)  coordinated referral and case management;                               
		(2)  develop with the Department of Information 
Resources automation standards for computer systems to enable 
health and human services agencies, including agencies operating at 
a local level, to share pertinent data;
		(3)  establish and enforce uniform regional boundaries 
for all health and human services agencies;
		(4)  carry out statewide health and human services 
needs surveys and forecasting;
		(5)  perform independent special-outcome evaluations 
of health and human services programs and activities;
		(6)  at the request of a governmental entity identified 
under Section 531.022(e), assist that entity in implementing a 
coordinated plan that may include co-location of services, 
integrated intake, and coordinated referral and case management and 
is tailored to the needs and priorities of that entity; and
		(7)  promulgate uniform fair hearing rules for all 
Medicaid-funded services.
	(b)  Rules promulgated under Subsection (a)(7), shall 
require that all Medicaid applicants and beneficiaries seeking 
services, including services that require prior authorization, are 
afforded due process protections (including protections required 
by 42 C.F.R. Part 431, Subpart E) including the following 
requirements:
			(A)  the notice informing an applicant or 
beneficiary of his or her right to a hearing must contain an 
explanation of the circumstances under which services are continued 
if a hearing is requested;
			(B)  the notice informing an applicant or 
beneficiary of his or her right to a hearing must be mailed at least 
10 days before a termination, suspension, or reduction of Medicaid 
eligibility or services, except as permitted by 42 C.F.R. Sections 
431.213 and 431.214; and
			(C)  if a hearing is requested before the 
termination, suspension, or reduction of Medicaid eligibility or 
services, action may not be taken until a decision is rendered after 
the hearing unless:
				(i)  it is determined at the hearing that the 
sole issue is one of federal or state law or policy, and the 
beneficiary is promptly informed in writing that services are to be 
terminated or reduced pending the hearing decision; or
				(ii)  the services sought to be continued 
pending the hearing decision did not have prior authorization 
during the preceding authorization period.